Center for Health and Biological Sciences, Pontifícia Universidade Católica do Paraná, Rua Imaculada Conceição 1155, Curitiba, PR, Brazil.
Nephron Clin Pract. 2011;118(4):c384-91. doi: 10.1159/000323664. Epub 2011 Feb 16.
Vitamin D [25(OH)D] deficiency is a cardiovascular risk factor in the hemodialysis (HD) population. The aim of this study was to identify hypovitaminosis D in HD patients without signs of hyperparathyroidism and to analyze its association to inflammation and echocardiographic alterations.
Patients on HD with iPTH <300 pg/ml not receiving vitamin D therapy were recruited. Hypovitaminosis D was defined as 25(OH)D <30 ng/ml. High-sensitivity C-reactive protein, interleukin-6 and serum albumin were used as inflammation markers. Echocardiograms were performed in an interdialytic mid-week day.
Sixty-one patients (mean age of 56 ± 15 years, 52% males, 93% Caucasians, 31% diabetic) were included, and 75% presented hypovitaminosis D. Inflammation was more prevalent among those with hypovitaminosis D, and these patients presented higher relative wall thickness (0.48 ± 0.11 vs. 0.42 ± 0.10 mm; p = 0.05) and lower left ventricular diastolic (49.8 ± 6.2 vs. 54.7 ± 5.8 mm; p = 0.013) and systolic (31.9 ± 5.7 vs. 36.8 ± 7.2 mm; p = 0.012) diameters.
Hypovitaminosis D is associated with inflammation and concentric geometric pattern of the left ventricle, even in the absence of high iPTH levels. Vitamin D repletion (aiming to reduce cardiovascular complications) should also be considered in HD patients with normal or low iPTH levels.
维生素 D [25（OH）D] 缺乏是血液透析（HD）人群的心血管危险因素。本研究旨在确定无甲状旁腺功能亢进迹象的 HD 患者中存在维生素 D 缺乏症，并分析其与炎症和超声心动图改变的关系。
招募 iPTH <300 pg/ml 且未接受维生素 D 治疗的 HD 患者。维生素 D 缺乏症定义为 25（OH）D <30ng/ml。高敏 C 反应蛋白、白细胞介素-6 和血清白蛋白用作炎症标志物。在无透析的周中进行超声心动图检查。
共纳入 61 例患者（平均年龄 56 ± 15 岁，52%为男性，93%为白种人，31%为糖尿病患者），75%的患者存在维生素 D 缺乏症。维生素 D 缺乏症患者的炎症更为常见，且这些患者的相对室壁厚度更高（0.48 ± 0.11 比 0.42 ± 0.10mm；p=0.05），左心室舒张末期直径更小（49.8 ± 6.2 比 54.7 ± 5.8mm；p=0.013），收缩末期直径更小（31.9 ± 5.7 比 36.8 ± 7.2mm；p=0.012）。
即使甲状旁腺激素水平正常或较低，维生素 D 缺乏症也与炎症和左心室向心性重构模式有关。因此，在 iPTH 水平正常或较低的 HD 患者中，也应考虑补充维生素 D（以降低心血管并发症的风险）。
